Archive for November 20th, 2012

Today’s guest blog post was contributed by Paul Gionfriddo, a former Connecticut State Representative and Mayor, who also served as a nonprofit CEO for more then fifteen years. Gionfriddo currently works as a consultant and writes a health and mental health policy blog, Our Health Policy Matters.

Many people think that people are chronically homeless because they have serious mental illness or addictions. They are wrong. They are homeless because of the way we treat their behavioral illnesses. Or fail to treat them.

Recently, I argued this point in an essay for Health Affairs that later appeared in the Washington Post. I wrote that the mistakes of an earlier generation of policy makers – a generation of which I was a part – caused so much of the problem.

Many years ago, we emptied our state psychiatric institutions for good reasons. They were often monuments to neglect or abuse. But when we emptied them, we failed to put in place the community-based service delivery system we needed.

Perhaps we had an excuse. We were in over our heads. No one knew much about the importance of behavioral health and primary care integration in the 1970s and 1980s. We had little understanding of PTSD as a debilitating mental illness. We had even less experience with educating children with serious behavioral illnesses in regular schools.

All we did was create a new revolving door, from brief hospitalization to incarceration to homelessness. I learned firsthand about this revolving door when my oldest son Tim entered it when he was just a teenager, after his behavioral health needs were often ignored or neglected throughout his school years.

This revolving door – this system that isn’t – is the reason people like my son become homeless. And, unless our policies change, it is the reason why young men and women like Tim will continue to become homeless.

For Tim and people like Tim, finding housing is not a start; it’s the end of a long process. And policymakers today have no excuse; they know what this process must be.

It should begin in our pediatricians’ offices, by mandating periodic screening of every child for mental illness and its risk factors. It should continue in our schools, by providing every student who has a mental illness with a meaningful special education program (and paying for it, as the law requires) that ensures they will graduate from a high school or vocational school.

It must be carried on by behavioral health service providers in the community, who can offer families all the supports they need when their children are living at home, and who can offer young adults like Tim all the treatment and supports they need when they are on their own.

And we must do everything we can to keep courts, sheriffs, and jails out of the treatment mix. After all, we don’t send people with cancer to jail just because they are symptomatic and noncompliant with their treatment, do we?

Doing these things will help to prevent chronic homelessness. And they will do something else, too – give some people who happen to be homeless today a real opportunity to become well and housed.

It will be a challenge for this generation’s policy leaders. Let us hope that they are up to it.